Sunday, May 26, 2013

I was reading a Huffington Post article last week and came across a new concept that sparked my interest. The article (http://www.huffingtonpost.com/adam-grant/does-trying-to-be-happy-m_b_3276701.html) was called "Does Trying to Be Happy Make Us Unhappy?" The author, Adam Grant, talked about something called obliquity. The concept comes from an economist (yep, an economist) named John Kay, who defines obliquity as the idea that goals are best achieved indirectly. He gives some examples of this paradox: the happiest people are not those who spend their lives pursuing happiness; the most profitable corporations are not those that make maximizing profits their primary goal; the wealthiest people are not those whose first priority is accumulating wealth.

What sparked my interest - of course - was the premise that the happiest people are not those who spend their time trying to be happy. In fact, as author Adam Grant points out, actively pursuing happiness actually ends up making people unhappy. This should give us all pause. Think about how much time and energy we (Americans, westerners) devote to building a happy life.

Ask the average adult what he or she wants in life. You'll probably get a variety of responses: a family, a big home in a safe neighborhood, a nice car, the time and money to travel the world, etc. But if you ask him why he wants these things, what he hopes to gain from having them, it really boils down to this: he believes these things will make him happy. In the end, most of us just want to be happy.

I imagine John Kay's advice would be this: if you want to be happy stop trying to be happy. According to Kay, basing our decisions in life on what we think will make us happy doesn't work. Why?

Kay explains his reasoning. In the real world, things don't happen in a straight line. One course of action generates a number of responses from different groups of people as well as from the environment; we simply cannot predict all of the possible responses in advance. If we want to be successful, we may need to adapt our strategies based on feedback from others. Issues emerge that might not have been immediately apparent in the beginning. Factors that did not initially seem relevant can later become a central concern. As circumstances change, our goals may need to change as well. It is therefore preferable to start out with a vague and imprecise objectives, as these are more flexible and adapt more easily to changing conditions.

Effective problem solving - and effective living, for that matter - involves trial and error. We often do not know whether a particular course of action will be effective until we try it. If we are rigidly committed to that course of action we will be reluctant to abandon it, even when it proves ineffective. Sometimes we have to be willing to abandon our objectives and change direction.

Kay stresses the importance of knowing what you don't know. We get into trouble when we assume we know how the world works or when we convince ourselves that we have more control over our environments that we actually possess. Successful people are ultimately those who recognize the limitations of their knowledge. In terms of happiness, this means acknowledging that we might not know what makes us happy. The world is full of people who chose a particular path because they thought it would make them happy, only to discover later that they are not happy at all.

In sum, if you want to be happy stop trying to be happy. Focus on other objectives. For me, I try to focus on goals like spending as much time with the people I love as possible. Yours goal might be different. I'd love to hear from you - what objectives do your pursue?

Sunday, May 19, 2013

As a psychotherapist, I'm used to dealing with crises. Crisis management is a job requirement for everyone who works in a mental health setting, from the lead psychiatrist to the people who answer the phones and schedule appointments. In college, a significant amount of class time was devoted to this topic.

What constitutes a crisis can differ from person to person and from setting to setting. When I worked in a residential setting, a crisis typically involved a patient becoming physically aggressive, destroying property, engaging in self harmful behaviors, or trying to run away from the facility. For an inpatient psychiatric hospital, the crisis is often admission to the facility itself (since people typically aren't admitted to an inpatient psychiatric hospital unless they are an immediate danger to themselves or others).

Crises also vary in size and scope. An individual can experience a personal crisis (for example, an "existential crisis"). Crises can also occur within a family. Often, a problem in an individual family member impacts the entire family, creating a family crisis.

Sometimes an event disrupts the lives of large groups of people, causing a neighborhood, state, or even national crisis. Natural disaster is a common example of a large scale crisis. Recall the 2011 earthquake and tsunami in Japan. Between nineteen and twenty thousand people died (most from the tsunami), leaving thousands of grieving friends and relatives in their wake. The resultant destruction left hundreds of thousands of people homeless. Entire communities were completely destroyed. The earthquake and tsunami also caused a nuclear power plant in Fukushima to meltdown. Eventually, the loss of energy supplied by the plant taxed the entire nation's electricity supply. The Japanese government was forced to look for alternative ways to meet the nation's electricity needs.

As a psychotherapist, the crises I deal with tend to be on a smaller scale. I think the majority of crises are small scale crises. You might think that dealing with so many crises makes a person better at handling them. There was a time when I was naive enough to believe this. The truth is, when you are confronted with crises on a daily basis you become good at dealing with other people's crises. And that's all. I've discovered that all of my training, education, and experience mean nothing when faced with my own crisis. This became abundantly apparent during a recent family crisis. I was no calmer nor any better equipped to deal with what happened. The first thing I did when I learned what had happened was to ask my mother what I should do. That's certainly not the most competent reaction.

What stood out the most to me was how helpless I felt. There was absolutely nothing I could do to change the situation. There were, of course, things I could do to be there for my family. Perhaps a bit ironically, I did not know which of these options would be comforting and which would be intrusive. I was torn between wanting very badly to be there but also wanting to respect the privacy of a loved one who was going through a terrible experience.

I'm not upset with myself for not knowing what to do. I'm not sure there is ever any "right" thing to do in a crisis anyway, although there are certainly "wrong" things to do. I've come to realize that it was naive of me to believe I would be better equipped to handle my own crisis just because I'm used to helping other people handle theirs.

Sunday, May 12, 2013

What happens when the person who is supposed to help others doesn't quite feel up to the task? This is something I've struggled with occasionally, particularly during the more turbulent periods of my life. I find it difficult to offer someone hope when I feel depressed myself. It's hard to be a calming presence when my own anxiety feels overwhelming. It's a challenge to find the energy to connect and engage with other people when what I really want is to hide from the world.

And yet, these are exactly the things I must do. In some ways this is an almost universal phenomenon; most of us are not at liberty to drop out of life just because we feel depressed or overwhelmed. No matter how bad we feel (or for how long), there are things that must be done; we have no choice but to do them. We must somehow set aside our feelings and fulfill our responsibilities.

Still, I think the experience of depression, anxiety, grief, or distress by mental health professionals puts them in an uniquely difficult position. How can a person help others at a time when she herself can hardly function?

After doing some research, I discovered that most mental health professionals do exactly what I do when I'm feeling emotionally overwhelmed: they go to work, do their job the best they can, and go home at the end of the day. Then they get up the next day and do it again. In a 1987 survey of clinical psychologists, 60% of those who responded acknowledged conducting psychotherapy when they felt they were "too distressed to be effective."

Some research suggests that psychotherapists might even be more vulnerable than the general population to experiencing anxiety or depression. Tillet (2003) calls this the "helping profession syndrome," which he describes as the phenomenon in which people are drawn into helping professions because of their own psychopathology. People who have struggled with anxiety or depression in the past have a higher risk than others of experiencing anxiety or depression in the future. Thus, the very factors that influence some people to pursue careers in fields like mental health also make these individuals more vulnerable future psychologically or emotional distress.

So what should the healers do when they themselves are hurting? Of course we should always take care of ourselves emotionally (and physically, for that matter). When we're hurting, we should be aware that we're having a hard time and that we will probably perform less effectively until things get better. Otherwise, we do the only thing we can do: keep doing our jobs, to the best of our ability.

Sunday, May 5, 2013

It is relatively common for people who have had some sort of traumatic experience to blame themselves for the event, even when it is clear they did not cause it. Some of these individuals readily acknowledge that they did not cause the event to occur; still, they hold themselves responsible for not preventing it. This is especially true when they can look back on the event and identify things they could have done differently that would have led to a better outcome.

Self-blame creates a lot of emotional suffering. This leads me to conclude that people do not choose self blame; in fact, many people attempt to convince themselves of their innocence. Barring that, they might try to avoid thinking about the event at all. Paradoxically, they find that no matter how hard they try not to think about the event they seem to think about it all the time. In turn, these unwanted thoughts remind them of their guilt. In this way, self-blame begins to consume more and more of their lives.

So how do you help someone overcome self-blame? It is not enough to tell them that they've done nothing wrong; they've probably heard this a million times already. There is very little anyone can say to convince them of their innocence; this is a conclusion they must reach on their own. As a therapist, I try to operate from the assumption that the patient has the answers; my job is to ask the right questions.

So what kind of things might I ask about?

What happened? It's important for me to have at least a basic understanding of what took place. For one thing, it helps to distinguish between appropriate and inappropriate guilt. There is always a possibility that the patient did in fact commit some act of wrongdoing. In such cases, the task is for the patient to learn to forgive himself. Either way, I need to know the basic facts in order to help the patient put the event in its appropriate context. If relevant, I sometimes ask patients to draw a little diagram so I can get an idea of the environment where the event took place and of where the patient was positioned in relation to other people. (You'd be surprised by how helpful this can be. Sometimes a diagram makes it immediately apparent that, for example, based on the patient's position in relation to others there was no way he could have caused, prevented, or otherwise intervened in the event).

If you went before a jury, would they find you guilty and convict you of causing the event? What specifically would they convict you of? This helps people to think about guilt from a different perspective by adopting the mindset of a hypotehtical jury member who has been instructed to consider only the facts.

Are you the only one to blame for the event? Or are there others who bear some responsibility? I often have patients make a "responsibility pie chart." I ask them to identify all of the people (or other entities) who played some role in causing the event and to assign a percentage of total blame to each one. (Remember, the total has to add up to 100%). Ultimately, most patients end up assigning themselves somehwere around 20 to 25% of the total "blame." I then ask: "Are you treating yourself like you're 25% responsible? Or are you treating yourself like you're 100% responsible?"

Do other people share the belief that you are to blame? If not, who do they blame? How did they reach this conclusion? What evidence did they use? Is this the same evidence you use?

If a friend or relative had a similar experience, would you blame them? If not, why? Are you holding yourself to a different standard?

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About Me

I'm a Licensed Clinicial Social Worker (i.e., a "sit on my couch and tell me your problems" therapist). I'm also a woman just like any other woman, with the same wants, needs, problems, thoughts, feelings, etc. Being a therapist gives me a unique perspective though -- I'm more self-aware than your average person and I understand why I do almost everything I do. (If I don't know why I usually set off on yet another journey to better understand myself). The title of my blog is "This is Me" but my hope is that it's not just about me -- it's about you too. I hope that you will find a little of yourself in my words and that in seeking to better understand myself others will have the opportunity to better understand themselves as well.